Treatment of Testicular Teratoma in Germany
Best children's hospitals and doctors for testicular teratoma treatment in Germany
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Testicular cancer is the most common malignancy in men under 35. Teratoma is a rare histological type that is resistant to chemotherapy. Its treatment usually requires removal of the testicle and retroperitoneal lymph nodes. The departments of urology at German hospitals perform laparoscopic and robot-assisted surgical procedures, which are more safe and less traumatic. Germany is a good choice if you want to treat testicular cancer in one of the countries offering advanced medicine.
Content
- What is teratoma
- Clinical symptoms
- Diagnostics
- Treatment principles
- When is active surveillance used
- Surgical treatment of teratoma
- Chemotherapy and radiation therapy
- Why is it worth undergoing cancer treatment in Germany
- Treatment in Germany with Booking Health at an affordable price
What is teratoma
Testicular germ cell cancer (tumors derived from germ cells) is the most common neoplasm in men under 35 years of age. These tumors are of two types: seminomas and non-seminomas. In turn, non-seminomatous germ cell cancer can be represented by one of four variants: choriocarcinoma, testicular embryonal carcinoma, yolk sac tumor, and teratoma.
Patients with pure teratoma are rare in clinical practice. Basically, teratoma cells are part of mixed testicular cancer.
Patients with teratoma are treated according to non-seminoma tumor protocols, but when choosing a therapeutic tactic, some features of teratoma are taken into account: it rarely metastasizes to distant organs, often invades the retroperitoneal lymph nodes, and has a low sensitivity to chemotherapy. Therefore, when treating patients with teratoma, preference is given to surgical techniques. The probability of curing testicular cancer depends on the quality of the surgical procedure performed and on the completeness of removal of the neoplasm and all metastases.
Cancer treatment in Germany is usually successful. Patients with teratoma can get rid of this disease even at the last stage. The country uses advanced technologies, so surgical interventions are becoming not only more effective, but also less traumatic. The surgical cancer treatment in Germany involves the use of not only conventional open operations, but also laparoscopic and robot-assisted interventions.
Clinical symptoms
The clinical signs of teratoma are nonspecific. They are the same as for any other testicular tumor. In addition, testicular tumors are often difficult to distinguish from other scrotal diseases by their clinical symptoms.
As a rule, the first clinical sign is an increase in the size of the entire testicle or the appearance of a lump on it. Pain syndrome is not among the frequent clinical manifestations of pathology. The presence of severe pain rather indicates inflammation of the epididymis or testicle.
Other clinical signs develop due to cancer spread:
- Back pain – in case of retroperitoneal lymph node metastasis.
- Abdominal pain – in case of lymph node metastasis and liver metastasis.
- Headaches, neurological symptoms – in case of brain metastasis.
- Shortness of breath, chest pain, cough – clinical signs of lung metastasis.
Diagnostics
The department of urology clarifies the patient's complaints, and conducts a clinical examination. Tissue palpation allows detecting the lump in the testicle, which is usually painless.
Regardless of what clinical symptoms the patient has when visiting a doctor, the first method of instrumental diagnostics in urology in the presence of scrotal complaints is ultrasound. In most cases, this method alone is sufficient to confirm the diagnosis.
If doctors find it difficult to distinguish the tumor from other masses (for example, testicular abscess), then other diagnostic tests are used. This is mainly MRI, since computed tomography gives radiation exposure to the genitals, and it has a bad effect on reproductive function.
Biopsy is not used for pathomorphological confirmation of the diagnosis. The doctor usually performs surgery to resect the tumor, and only after that it is possible to establish its histological type.
To determine the clinical stage of the disease, instrumental studies are used:
- Chest x-ray.
- CT scan of the retroperitoneal space, liver, lungs.
- MRI of the brain.
- PET.
To assess the patient's state of health prior to surgical interventions and chemotherapy, his clinical condition is assessed. Patients undergo a complete blood count, a clinical urinalysis, a biochemical blood test, a coagulogram, tests for blood-borne infections.
Treatment principles
Patients with teratoma receive different treatment options, depending on the clinical stage of the disease and the risk group for recurrence, and progression. The risk can be high, intermediate, or low. It is graded on the IGCCCG (International Germ Cell Cancer Collaborative Group) scale. The risk is assessed by the clinical, biological characteristics of the tumor and tumor marker levels.
Without exception, all patients with teratoma, regardless of the stage of testicular cancer, require surgery for primary tumor removal. Radical inguinal orchiectomy (orchifuniculectomy) involves the resection of the testicle, epididymis, and spermatic cord.
In the future, patients with the early stage of testicular cancer receive various therapeutic tactics:
- Active surveillance.
- Retroperitoneal lymph node dissection.
- Chemotherapy.
If the tumor is large, and already at the phase of clinical staging doctors determine its blood vessel invasion or lymph node metastasis, then retroperitoneal lymph node dissection can be performed immediately. It is often performed during the same surgery as testicle resection. Chemotherapy may also be required after surgery. It is necessary with the increased tumor marker levels or if pathomorphological examination reveals remote lymph node metastases.
In stage 2B, doctors may start treatment with chemotherapy followed by lymph node removal. In most cases of testicular cancer, chemotherapy completely destroys retroperitoneal lymph node metastases in half of the patients, but in case of teratoma, this treatment option gives the same result only in 15% of patients. The remaining 85% have cancer foci in the lymph nodes detected during the pathomorphological examination of the removed material. Nonetheless, with a well-performed surgical intervention, the disease can still be cured, since all tumor foci are removed, and distant metastases are rare for teratoma.
And yet, there are such cases. When distant metastases spread, doctors diagnose stage 3, which is the final stage of testicular cancer. It is more difficult to treat this pathology. Not all patients respond to chemotherapy, so sometimes it is necessary to resort to metastasis removal surgery, and irradiation of metastatic foci.
Since the majority of patients with teratoma are young people (the average age at diagnosis is 27 years), they can be treated with high-dose chemotherapy and subsequent stem cell transplant. This is a complex, costly and unsafe treatment, but sometimes this is the only way to cure the final stage of cancer: high doses of chemotherapy can overcome the tumor's drug resistance, but destroy the bone marrow. To restore hematopoietic function, the patient undergoes an intravenous injection of donor stem cells.
When is active surveillance used
If the teratoma is small and has not spread to the blood vessels, active surveillance becomes an option of choice. Under these circumstances, the risk of testicular cancer metastasis spread to the retroperitoneal lymph nodes is low. Many patients can avoid traumatic surgery to remove them or chemotherapy, which has many side effects. Nevertheless, active surveillance is required for detecting the recurrence of testicular cancer from the lymph nodes in time, if any.
Most relapses occur in the first 2 years after surgery. Therefore, it is during this period that the diagnostic examination is carried out with the maximum frequency. In the first year, the patient comes to the doctor of the department of urology for the clinical examination once every 2 months and has tumor marker testing, and once every 4 months he undergoes computed tomography to assess the size of the retroperitoneal lymph nodes. In the second year, the frequency of visits to the doctor and laboratory tests is once every 3 months, and CT scan is enough to do once every 6 months. From the third year onwards, it is enough to visit the department of urology for the clinical examination and laboratory tests once every six months, and CT scan is done once a year.
Some patients with testicular cancer will eventually relapse, but this will not affect the chances of curing the disease. It just needs additional treatment. The therapy for testicular cancer can be different: chemotherapy, surgery, radiation therapy. When treating patients with teratoma, doctors prefer surgery because the tumor has low sensitivity to chemotherapy and radiation. The treatment of patients with other types of testicular cancer is more often based on the use of chemotherapy.
Surgical treatment of teratoma
Surgical treatment of testicular cancer includes:
- Surgery to remove the testicle affected by the tumor – it is performed for all patients with teratoma, regardless of the clinical stage at which the diagnosis is made.
- Retroperitoneal lymphadenectomy – it is usually performed for retroperitoneal lymph node metastasis detected by clinical methods, as well as if there is a high risk of metastatic spread.
- Surgery to remove metastases in the lungs, liver, brain and other organs – it is rarely used, since teratoma usually does not metastasize to distant organs and lymph nodes.
The most complex stage of surgical treatment is retroperitoneal lymphadenectomy. This operation is technically difficult for the doctor and traumatic for the patient. In the standard version, it is done through a large incision in the skin.
But Germany and other countries with advanced medicine use minimally invasive techniques. When performed in specialized medical centers with extensive experience, laparoscopic interventions provide the same oncological outcomes. These operations are performed through short incisions with thin long instruments. To monitor their actions, doctors use a tiny video camera, which is inserted through one of the ports.
The best urology clinics in Germany perform cancer surgery using a robotic system. The doctor controls it remotely using a remote control. The robotic system provides ideal visualization of the operating field, greater freedom of movement, and instant coagulation of blood vessels. As a result, patients are less likely to suffer from complications, lose less blood, need less postoperative pain relief, recover faster, and spend less time in the hospital.
The likelihood of the cure for testicular cancer depends on whether the doctor completely removes the lymph nodes. With the well-performed surgical intervention, the survival rate of patients increases, and the risk that a second operation for tumor recurrence will be required in the future is low. Therefore, it is better to undergo teratoma treatment in countries with advanced medicine. Thus, you can avoid unnecessary health risks and cure cancer with the safest, least traumatic methods.
Chemotherapy and radiation therapy
The treatment of teratoma involves the use of chemotherapy, but it plays a lesser role than in any other testicular cancer. The chemotherapy drugs can be used in the advanced stages. They can be used before and after surgery.
Nevertheless, if the doctor of the department of urology has a choice: to treat teratoma with surgery or chemotherapy (in the early stages of the disease), then surgery is preferred. This is due to the fact that it provides better patient survival rates as not all patients with teratoma respond to chemotherapy.
Irradiation is often used only for seminoma. These tumors are very sensitive to radiation. With teratoma, radiation therapy is used much less often, usually only at the final stage of the disease. Radiation helps control distant metastases. Metastatic foci in the brain are most often irradiated. The treatment option is used if chemotherapy does not work or if the tumor needs to be reduced quickly due to the threat of complications.
Cancer treatment in Germany uses advanced methods of radiation therapy. They allow tumors to be irradiated faster (in fewer sessions) and safer. Gamma Knife and CyberKnife stereotaxic devices are used for brain metastasis suppression. They can destroy small metastatic foci even within a single irradiation procedure.
Why is it worth undergoing cancer treatment in Germany
It is better to undergo testicular cancer treatment in Germany. This country uses advanced diagnostic and treatment methods. There are several reasons for you should go to Germany:
- Accurate diagnosis: identification of the type of tumor, detection of metastases, determination of the risk group for the optimal choice of treatment tactics.
- Retroperitoneal lymphadenectomy is performed with the use of laparoscopic techniques.
- Advanced departments of urology perform robot-assisted surgery.
- The use of nerve-sparing surgical technique that helps the patient avoid ejaculation problems.
- High efficiency of surgery: doctors with extensive experience remove all lymph nodes in which there may be metastases, so the teratoma does not recur even many years after treatment.
- Modern chemotherapy regimens based on international protocols are used for reducing the risk of recurrence in the advanced stages.
- High-quality accompanying treatment minimizes the risk of complications.
- Successful cancer treatment even at the advanced stage, after the spread of distant metastases.
Treatment in Germany with Booking Health at an affordable price
To undergo testicular cancer treatment in one of the German hospitals, you can use the services of the Booking Health company. On our website, you can find out the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in German hospitals will be easier and faster for you, and the cost of treatment will be lower.
You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a consultation on treatment in Germany. Booking Health will fully organize your trip to this country. We will provide the following benefits for you:
- We will select the best German hospital, whose doctors specialize in testicular cancer treatment.
- We will solve the problem of the language barrier, and we will provide communication with the doctor of the department of urology at the German hospital.
- We will reduce the waiting time for the medical care program. You will undergo treatment in the department of urology on the most suitable dates.
- We will reduce the price. The cost of treatment in Germany will be reduced due to the lack of overpricing and additional coefficients for medical tourists.
- We will take care of organizational issues: we will prepare documents, meet you in Germany and take you to the hospital, book a hotel, and provide interpreting services.
- We will prepare a medical program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
- We will help you keep in touch with doctors after the completion of treatment in Germany.
- We will organize additional diagnostic examinations and treatment in the German hospital, if you still need medical services.
- We will buy medicines in Germany and forward them to your native country.
Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help reduce the cost of treatment, organize your trip to the German hospital, and you can fully focus on restoring your health.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko